 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||||
| |||||||||||||
Administrative Letter No. 09-15 - Reduction in the Special Assistance Adult Care Home (SA/ACH) Basic Rate and Maintenance Amount
N.C. Division of Aging and Adult Services, Adult Services Section
Date: |
August 31, 2009 |
Subject: |
Reduction in the Special Assistance Adult Care Home (SA/ACH) Basic Rate and Maintenance Amount |
Distribution: |
County Directors Special Assistance Supervisors Adult Services Supervisors |
Effective Date: |
October 1, 2009 |
Session Law 2009-451, the State’s ratified budget, was signed by Governor Perdue August 7, 2009. The law contains a provision to decrease the maximum SA/ACH Basic facility rate effective October 1, 2009. The effect of this change on the SA/IH program is addressed in DAAS Administrative Letter 09-16.
Effective October 1, 2009, the maximum SA/ACH Basic rate will decrease from $1,207.00 to $1,182.00.
Effective October 1, 2009, the Maintenance Amount for SA recipients with an Ambulation Capacity Code “B” will decrease from $1,253.00 to $1,228.00 ($1,182.00 + $46.00, personal needs allowance).
Due to the facility rate decrease, the Total Countable Monthly Income (TCMI) limit to qualify for SA/ACH Basic benefits will decrease from $1,252.50 to $1,227.50.
Individuals currently receiving SA/ACH Basic benefits, whose TCMI is between $1, 227.51 and $1,252.50 will continue to be eligible for SA/ACH Basic as long as they continue to meet all other SA eligibility requirements. These individuals are considered “exempt” SA/ACH Basic recipients who will be designated in EIS by Ambulation Capacity Code “E”.
Exempt recipients with Ambulation Capacity Code “E” remain eligible at the same payment level as long as they meet the following requirements:
1. The application is taken prior to October 1, 2009, and
2. The recipient resides in an adult care home on September 30, 2009 and
3. Is eligible for SA/ ACH Basic benefits on September 30, 2009, and
4. The recipient’s TCMI is less than $1,252.51.
If an exempt recipient’s SA is terminated or transferred to another aid program/category, exempt “E” status ends. If the client later reapplies for Special Assistance, he/she must meet the current SA/ACH Basic, or SA/ACH SCU eligibility requirements.
On the night of September 25, 2009, EIS will automatically update active SAA and SAD cases to reflect the new SA/ACH Basic rate and the new SA/ACH Basic Maintenance Amount, effective October 1, 2009.
Do not send a notice for the October checks. A notice will be mailed with the September checks. A copy of the notice is attached in Figure 1.
1. For each active SAA or SAD case in EIS with an Ambulation Capacity of “B” and TCMI of $1,227.50 or less, on the night of September 25, 2009, EIS will:
a. Change the Domiciliary Rate to $1,182.00
b. Change the Maintenance Amount to $1,228.00
2. For each active SAA or SAD case with an Ambulation Capacity Code “B” and TCMI of $1,227.51 - $1,252.50, EIS will:
a. Change the Ambulation Capacity Code to “E”.
b. Leave the Domiciliary Rate at $1,207.00
c. Leave the Maintenance Amount at $1,253.00
3. EIS will update the monthly payment amount by subtracting TCMI from the new Maintenance Amount, minus any grant recoupment and rounding the difference to a whole dollar. The payment effective date will change to October 1, 2009.
4. Case profiles will be created and mailed to the counties.
For applications pending on October 1, 2009 with an eligibility effective date prior to October 1, 2009, and the date of application is prior to October 1, 2009, approve the application with a Payment Effective Date of October 1, 2009. Authorize months prior to October 2009 in the Retro 1 and 2 fields on the EIS DSS-8125 screen.
1. For eligible months prior to October 1, 2009, if TCMI is $1,252.50 or less, approve payments as Ambulation Capacity Code “B" with a Maintenance Amount of $1,253.00 and a Domiciliary Rate of $1,207.00 for those months.
2. For eligible months beginning October 1, 2009 and ongoing, if TCMI is $1,227.50 or less, approve the case as Ambulation Capacity Code “B" with a Maintenance Amount of $1,228.00 and a Domiciliary Rate of $1,182.00. Enter these payments in the Retro Pay field on the EIS DSS-8125 screen.
3. For eligible months beginning October 1, 2009, if TCMI is $1,227.51 - $1,252.50, approve the case as Ambulation Capacity Code “E” with a Maintenance Amount of $1,253.00 and a Domiciliary Rate of $1,207.00.
NOTE: A window will be provided in EIS to allow Ambulation Capacity Code changes from ‘B’ to ‘E’ or ‘E’ to ‘B’ beginning September 26, 2009 through October 27, 2009. Changes in Ambulation Capacity Code from “B” to “E” or from “E” to “B” will not be allowed after October 27, 2009.
For applications taken prior to October 1, 2009, and still pending on October 1, 2009 with an eligibility effective date of October 1, 2009 or later, approve the case as Ambulation Capacity Code “B” using the new SA/ACH Basic Maintenance Amount of $1,228.00 and Domiciliary Rate of $1,182.00. Do not approve applications with income greater than $1,227.50.
Use the new SA/ACH Basic Maintenance Amount of $1,228.00 and Domiciliary Rate of $1,182.00 for all applications taken on or after October 1, 2009. Do not approve applications with income greater than $1,227.50.
The following reports will be available in NCXPTR on September 26, 2009. Follow the instructions below for each report. Reports are sorted by county and by district number within the county. Payees in each district number are listed in alphabetical order by last name with case ID and county case number.
A. ‘SA RATE DECREASE AMBULATION CAPACITY CODE B’ is an NCXPTR report of cases updated with the new Maintenance Amount of $1,228.00 and the new Domiciliary Rate of $1,182.00, with an Ambulation Capacity Code ‘B”. The report includes all SAA and SAD cases updated in the mass change.
B. ‘SAA/SAD AMBULATION CAPACITY CODE CONVERSION ‘B’ TO ‘E’ is an NCXPTR report of SAA and SAD cases with Ambulation Capacity Code Change from ‘B’ to ‘E’ .
The reports in A. and B. above include:
1. County Number/Name
2. Casehead Payee Name
3. District Number
4. Case ID Number
5. Total Countable Monthly Income
6. Maint Amount Before Mass Change
7. Maint Amount After Mass Change
8. Domiciliary Amount Before Mass Change
9. Domiciliary Amount After Mass Change
10. Payment Amount Before Mass Change
11. Payment Amount After Mass Change
12. Ambulation Capacity Code Before Mass Change
13. Ambulation Capacity Code After Mass Change
C. ‘CASES UPDATED – REVIEW NEEDED’ is an NCXPTR report that counties must work and correct no later than October 27, 2009. This report includes SAA and SAD cases that were updated but further review of the case is needed. Two different errors may be noted by the following error messages:
1. “TOT MO INC NOT BAL” – Cases that contain Total Net Unearned Income and Net Earned Income amounts that added together do not equal the Total Countable Monthly Income plus $0.00 to $20.00 exclusion.
2. “MAINT NOT $1253/DOM NOT $1207” – Cases that contain a Maintenance Amount not equal to $1253.00 and/or Domiciliary Rate not equal to $1,207.00.
The reports in 1. and 2. above include:
a. County Number/Name
b. District Number
c. Total Countable Monthly Income
d. Maint Amount Before Mass Change
e. Maint Amount After Mass Change
f. Domiciliary Amount Before Mass Change
g. Domiciliary Amount After Mass Change
h. Case ID Number
i. Message
D. ‘Zero Payment Report’ is an NCXPTR report of case EIS updated and recalculated with a payment amount less than $5.00.
The report includes:
1. County Number/Name
2. Casehead Payee Name
3. District Number
4. Case ID Number
5. Payment Before Mass Change
6. Payment After Mass Change
E. ‘Error Report - Cases Not Updated’ is an NCXPTR report of cases
that EIS could not update. Included on this report are cases that could not be updated for the following reasons:
1. “UNEARN INC = ZERO” – Cases that contain no entries for Total Net Unearned Income or Total Countable Income.
2. “CASE PENDING” – Cases that contain a pending DSS-8125.
The reports in 1. and 2. above include:
a. County Name/Number
b. District Number
c. Case ID Number
d. Casehead Payee Name
e. County Case Number
f. Error Message
If you have any questions regarding this information, please contact your Adult Programs Representative.
Sincerely,
Dennis W. Streets, Director
DWS/SPM:bp
Attachment
IMPORTANT NOTICE TO
RECIPIENTS OF SPECIAL ASSISTANCE FOR ADULTS
The 2009 Session of the North Carolina General Assembly approved a change in the Special Adult Care (SA/ACH) Basic rate for most recipients of Special Assistance. Beginning October 1, 2009, the rate that you pay the facility each month is decreased from $1,207 to $1,182. Your SA check may be decreased beginning in October 1, 2009 because of the decrease in the rate you pay the facility.
The decrease in the SA/ACH Basic Rate also means that if you receive Special Assistance In-Home (SA/IH) your payment may decrease effective October 1, 2009, since the SA/IH payment is based on 75% of the new SA/ACH Basic payment amount.
Exception 1: There is a small group of people who will continue to pay a rate of $1,207 per month. The rate for this group will not change.
Exception 2: There is no rate change for recipients residing in a Special Care Unit for Alzheimer’s or related disorders. The Special Care Unit rate will remain $1,515.00 per month.
Hearing Rights: If you disagree with this decision, you have a right to ask for a hearing. To ask for a hearing, call or write your caseworker within sixty (60) days from the date of this notice, which is October 30, 2009. If you do not ask for a hearing by that date, you cannot have a hearing. If you request a hearing, a local hearing will be held within 5 days of your request unless you ask for it to be postponed for good reason for an additional 10 days. The hearing will establish whether this action was correct. Then, if you think the decision in the local hearing was wrong, call or write your caseworker within 15 days of the local hearing to ask for a second hearing before a state hearing officer.
You may have someone speak for you at your hearing, such as a relative or an attorney obtained at your expense. Free legal services may be available in your community. Contact your caseworker for information on free legal services.
If you ask, your caseworker will show you and the person speaking for you your eligibility record before your hearing. You may ask to see other information used at the hearing.
Attachment 1
|
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
| |||||||||||||